Health policy and planning最新文献

Addressing men's own specific health concerns in the context of sexual and reproductive health (SRH) remains a largely neglected topic, despite growing levels of unmet SRH needs among men and the broader benefits of engaging men in the SRH of women and others. A comprehensive policy analysis explored how men are currently addressed and characterized within 37 key global and regional SRH-focused policies. Men's own SRH was found to be a significantly neglected policy issue. Less than half (43%) of the policies provided reference to men's SRH, and only 16% purposefully outlined steps to address men's own SRH needs. This contrasted with 78% of policies addressing women's SRH. Policies rarely provided sex disaggregated data nor targets on men's SRH outcomes. The inclusion of men was typically for solely instrumental reasons-in order to improve women's SRH. Men's SRH was best addressed within language on HIV and sexuality transmitted infections (STIs), particularly for men who have sex with men. Policy coverage was poor on men's SRH needs and roles in relation to contraception, fertility, sexual dysfunction, reproductive cancers, sexual pleasure, healthy relationships. and SRH-related discrimination. Only a quarter (24%) of the policies included a focus on one or more vulnerable male sub-group, with inadequate policy attention to the specific SRH needs of older men, disabled men, men living with serious health conditions, transgender people, and heterosexual men. An absence of focus on men's distinct SRH needs, alongside that of women, limits global understanding and visibility of SRH challenges particular to men, impeding the formulation of policies, programs, and funding priorities that sufficiently address men's needs. It also reinforces SRH as a women's sole burden and entrenches gender inequalities. Health policies should prioritize men's increased access to SRH information and care and better frame SRH as a critical part of men's lives.

The global health landscape is undergoing a significant transformation as traditional frameworks of cooperation face fragmentation amid geopolitical tensions. Declining support from Western nations, exemplified by US withdrawal from the World Health Organization and cuts to programs like the President's Emergency Plan for AIDS Relief, has exposed the profound instability of an aid architecture built on colonial dependencies. The COVID-19 pandemic, marked by vaccine nationalism, was a stark litmus test of this systemic failure for low- and middle-income countries (LMICs). This commentary argues that the current geopolitical fragmentation, while a crisis, also presents a critical opportunity to dismantle colonial legacies and reimagine global health equity not as a donor-driven ideal, but as a practice of shared power and sovereignty. We first document the rise of alternative pathways, critically examining China's health diplomacy and India's pharmaceutical disruption, while highlighting robust, LMIC-led initiatives like the African Medicines Agency and local mRNA vaccine production in Rwanda and Thailand. In response to the fractured status quo, we then propose a new global health compact built on four interdependent pillars: (i) Epistemic Justice, valuing local knowledge systems; (ii) Structural Audacity in Financing, such as taxing multinational corporations for reparative funding; (iii) Governance for Agency, ceding decisive power to LMICs; and (iv) Open Knowledge and Innovation, by dismantling restrictive intellectual property regimes. Achieving this decolonized future requires concrete action from all stakeholders. We conclude with a blueprint urging high-income countries to cede power, LMICs to invest in local capacity, funders to provide untied financing, and researchers to practise equitable collaboration. This actionable agenda is the foundation for a truly equitable global health system capable of achieving Universal Health Coverage.

Intervention evaluation is critical for determining the value of health interventions; however, real-world implementation frequently falls short of achieving anticipated large-scale impacts. This evidence-to-practice gap often arises from challenges in capturing the complexity inherent in intervention implementation. This complexity may stem from the intervention itself, the dynamic and interrelated processes of dissemination, implementation, and sustainment, or the constraints of real-world settings characterized by interconnected systems. Integrating implementation science, which employs theories, models, and frameworks to understand the adoption and integration of evidence-based interventions, with systems science, which provides tools to model and analyze complex systems, offers a promising pathway for addressing these challenges. However, practical guidance on combining these approaches to evaluate dynamic interactions between interventions and implementation contexts, while simultaneously capturing system-level learnings, remains limited. In this methodological musing, we reflect on our experience integrating systems and implementation science to develop a conceptual and quantitative model for scenario evaluation of a maternal health service delivery redesign initiative in Kakamega, Kenya. We use four research objectives as a touchstone for organizing our reflections, explicated by three steps of an evaluation process: (i) developing a qualitative systems model using implementation frameworks and causal loop diagrams; (ii) constructing and parameterizing a quantitative computational model; and (iii) conducting scenario analyses to explore "what-if" strategies and inform adaptive planning. These reflections highlight the potential strengths of an integrated approach and offer practical considerations for researchers and practitioners evaluating complex health interventions through quantitative modeling and scenario development.

Digital health information systems have the potential to improve data-driven decision-making and strengthen primary health care delivery in low- and middle-income countries (LMICs). This study examines Rajasthan, India's public health information systems with an aim to describe data processes and identify key barriers and opportunities for improvement. Using a qualitative approach, we conducted in-depth interviews with 39 stakeholders, including frontline health workers and state health officials. Our findings highlight inefficiencies in parallel paper and digital reporting systems, leading to high health worker burden, redundant data entry, delays in patient care, and poor data accountability. While digital platforms have improved data accessibility and care coordination, challenges such as poor interoperability, IT infrastructure limitations, and gaps in digital literacy remain. Lessons from successful digital health implementations in other LMICs suggest that integrated, human-centered, and interoperable systems are critical for sustainable digital transformation. We propose a "5I Framework" for policymakers to streamline Rajasthan's digital health ecosystem: (1) Integrated platforms, (2) Implementable systems co-designed with health workers, (3) Ink-free transitions away from paper-based systems, (4) Insights from geospatial and real-time data, and (5) Incentives aligned with workforce needs. Strengthening Rajasthan's digital health systems through these strategies can enhance service delivery, improve public health outcomes, and serve as a model for other LMICs.

Qualitative research findings are sometimes used in guideline development, but usually in an ad hoc manner. We sought to explore how qualitative research could contribute to guideline development, identify examples of qualitative research being used to inform guideline development, and gather suggestions for how qualitative research might be incorporated more systematically in guideline development. Using a topic guide, in 2022-24, we interviewed experts who had participated in World Health Organization (WHO) guideline development. We used purposeful sampling, including qualitative researchers, guideline developers, guideline panel members, and implementation researchers. We interviewed 16 participants, and identified three themes: (i) respondents endorsed using qualitative research findings in developing WHO guidelines, and highlighted examples where this approach had been useful; (ii) recommendation questions in the guideline process are built on clinical decision-making, which can sometimes be too detached from social contexts for broader health problems; (iii) using qualitative research findings to help delineate context has a greater potential role in guidelines. We interpret these findings to indicate that qualitative research could be used more systematically, particularly to inform a broader framing of a health problem, or later in recommendations, to tailor to particular contexts.

Research on health system capacity to manage non-communicable diseases (NCDs) has largely focused on 'system hardware' such as infrastructure, workforce, and commodities. However, this overlooks the critical role of 'system software' elements such as relationships, norms, and power, and the complex adaptive nature of health systems. This study aimed to explore how health system hardware and software elements interact to shape the capacity of the health system to deliver hypertension care in Kilifi County in the coastal region of Kenya. We conducted a cross-sectional qualitative study and collected data using document reviews (n=14) and in-depth interviews with purposively selected front-line health workers (FLHWs) at five health facilities and health managers at county and national levels (n=37). We applied a framework approach to data analysis, utilizing complex adaptive systems (CAS) theory as our analytic framework. Complex interactions of system hardware and software elements constrained the provision of hypertension care. Frequent medicines stockouts (hardware) stemmed from budgetary gaps, procurement delays, regulatory restrictions, and weak quantification practices (software). To mitigate medicines shortages, facilities employed adaptive responses such as inter-facility borrowing and sourcing from alternative suppliers (software). Access and continuity of care were enabled by organizational norms like dedicated hypertension clinic days (software) but undermined by inadequate consultation rooms, staff shortages (hardware) and limited training and support supervision (software). FLHWs' ideas to improve medication adherence were undermined by staff shortages (hardware) and inadequate support from facility managers (software), weakening service delivery. The application of CAS theory unpacked the hitherto underexplored aspects of health system capacity. System 'software' plays a central role in shaping health system capacity for hypertension care. Therefore, strengthening health system capacity for NCDs requires coordinated investment in both system hardware and software elements. Importantly, system strengthening interventions should consider the CAS nature of health systems to foster conditions for productive emergence.

Sub-Saharan Africa (SSA) is experiencing an epidemiological transition where non-communicable diseases are becoming the leading cause of disability and mortality alongside infectious diseases such as HIV/AIDs. Multimorbidity, the coexistence of two or more long-term conditions, is increasing in SSA. However, the cost of managing multimorbidity is largely unknown. This study aimed to estimate the economic cost of public outpatient primary care for adults with multimorbidity (HIV, hypertension, and/or diabetes, and their associated conditions, cardiovascular disease and TB) in rural South Africa. This study used a cross-sectional, retrospective cost-of-illness approach to estimate the direct and indirect costs of multimorbidity management in Bushbuckridge, Mpumalanga, in 2022. Data was synthesized from patient-level data from eight public primary healthcare facilities within the Agincourt study site - a rapidly transitioning rural South African setting. Additionally, government reports and an existing study on transport costs and productivity losses conducted within the Agincourt study site were used to estimate the costs of managing patients in the primary care facilities. Results showed that patients with multimorbidity had higher average economic costs per patient compared to those with single conditions. Overall, patients with multimorbidity increase costs above the baseline of a patient with a single condition (R4 900/annum) by between 42% - 83%. Patients with multimorbidity also incur slightly higher costs associated with accessing primary care services compared to those with a single condition. However, our model shows that the additive cost of managing multiple conditions in separate consultations is higher than managing all conditions in a one visit. This shows that managing patients within an integrated care model seems to have a cost-limiting effect. However, treatment guidelines for managing multimorbidity in South Africa should be developed to ensure standardised care.

As countries progress through the 'nutrition transition' and experience rising rates of obesity and non-communicable disease, concern has broadened from a primary focus on economic consequences of child stunting, to incorporate multiple forms of malnutrition, including overweight and obesity, or a more ambitious set of individual dietary risk factors from the Global Burden of Disease work. This paper conceptualizes a methodology which uses unhealthy diets to better understand the economic impact as the nutrition transition progresses. The Lives Saved Tool (LiST) is used to estimate how much healthier diets alone (without other health interventions) can reduce future child stunting. The Global Burden of Disease Results Tool is used to estimate how much healthier diets can reduce future non-communicable disease among adults, via effects on three metabolic markers (high body mass index -BMI, high systolic blood pressure, and high fasting blood glucose). We then link the metabolic markers to diet quality (measured by the Global Diet Quality Score). Calculations are made for the Philippines for 2014 and 2021 and Ethiopia for 2011 and 2019. Recent studies have estimated the present value of future child stunting costs as 2.0% of GDP for the Philippines and 5.25% for Ethiopia, in both cases in 2023, of which we estimate up to 45% and 50% respectively are avertible over the long run by healthier diets, while public nutrition and public health programs account for the rest. The present value of costs associated with the three metabolic markers among adults are estimated as 7.99% of GDP (Philippines 2021) and 2.15% (Ethiopia 2019), of which we estimate 20% is avertible by healthier diets. The total losses avertible by healthier diets are therefore estimated as 2.5% of GDP (Philippines 2021) and 3.1% (Ethiopia 2019), with metabolic factors predominating in the Philippines and stunting in Ethiopia.

This study develops an inverse rank-weighted index (IRWI) to adjust catastrophic thresholds for out-of-pocket expenditure (OOPE) components. The proposed method eliminates the arbitrariness of the existing proportionate approach by ensuring fairness in determining component-specific catastrophic thresholds. It measures the effective expenditure share of each OOPE component while considering the concentration of component-specific spending across household income levels. Using nationally representative household survey data on healthcare consumption from 2017-18, the study estimates catastrophic health expenditure (CHE) at both aggregate and component levels in India under uniform, proportionate, and IRWI thresholds. The findings reveal that the uniform threshold significantly underestimates CHE incidence, whereas component-specific thresholds identify twice as many households that experience CHE. Shifting from the proportionate method thresholds to IRWI thresholds significantly alters CHE estimates. The IRWI approach offers a more reliable framework for integrating component-specific and aggregate CHE assessments. It underscores the need for income-sensitive, component-specific thresholds to accurately quantify financial hardship and prevent underestimating healthcare-related economic burden.

Recent reductions in U.S. global health funding have disrupted essential programs in sub-Saharan Africa (SSA), highlighting the region's vulnerability to external financing shocks. The suspension of USAID initiatives has affected disease control, maternal care, and health system operations across 47 countries, raising urgent questions about how to sustain progress without reliable donor support. This commentary examines the potential of Public-Private Partnerships (PPPs)-structured collaborations in which governments and private actors share financing, risk, and managerial responsibility-to strengthen domestic capacity. Drawing on examples from Senegal, Nigeria, and Kenya, we explore how service, concession, financing, and technology-focused PPPs can mobilize additional resources, expand access, and improve service delivery. We also address key challenges, including governance risks, fiscal constraints, and shifting global power dynamics. While not a substitute for aid, well-designed PPPs aligned with national priorities can support more resilient, equitable, and self-reliant health systems in SSA.